Update: New LI-RADS v2024 Surveillance Ultrasound Algorithm

The American College of Radiology LI-RADS Committee have released updated recommendations for US surveillance in patients with risk factors for HCC, now termed the LI-RADS v2024 Surveillance Ultrasound algorithm. 

Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, with an increasing incidence rate in Australia. Underlying liver disease such as cirrhosis and hepatitis B are the main risk factors for HCC development, and ultrasound (US) represents the core imaging surveillance tool in these patients, with regular 6 monthly surveillance studies.

The LI-RADS Committee have produced numerous guidelines relating to HCC and liver imaging, covering US, CT/MRI and contrast-enhanced US. The LI-RADS v2024 Surveillance Ultrasound algorithm incorporates updated recommendations derived from evidence generated since the introduction of US LI-RADS v2017,  and also further aligns with the AASLD guidelines released in 2023.

Major changes include:

1. New recommendations for poor visibility scans
2. Suggested imaging pathway in the setting of positive AFP
3. Updated terminology for visualisation scores and steatotic liver disease

The core guidelines can be accessed at:  LI-RADS v2024 Surveillance Ultrasound